Real-World Antiseizure Medication Prophylaxis and Outcomes in Hospitalized Adults with Acute Brain Injuries.

IF 3.6 3区 医学 Q2 CLINICAL NEUROLOGY
David Cheng, Marta Bento Fernandes, M Brandon Westover, Lidia Moura, Sahar F Zafar
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引用次数: 0

Abstract

Background: There is low-quality evidence for antiseizure medication (ASM) prophylaxis in acute brain injuries. We examined ASM prophylaxis patterns and explored the association with hospital outcomes in acute brain injury.

Methods:  We analyzed the PINC AI Healthcare Database with data from more than 1,400 US hospitals. We included adults aged ≥ 18 years admitted for at least 2 days with acute brain injury (International Classification of Diseases codes for ischemic stroke [IS], hemorrhagic stroke [HS], and traumatic brain injury [TBI]) and excluded potential prevalent users and patients with epilepsy/seizures. Index date was the second day of admission. The ASM prophylaxis cohort received levetiracetam or phenytoin on the index date; the control cohort did not receive any ASM on the index date. Outcomes were time-to-mortality and time-to-home discharge.

Results: In total, 739,213 patients were eligible: 568,254 with IS, 86,842 with HS, and 84,117 with TBI. ASM prophylaxis was prescribed in 10,959/568,254 (2%) patients with IS, 31,970/86,842 (37%) patients with HS, and 38,331/84,117 (46%) patients with TBI. Patients on prophylaxis more frequently received mechanical ventilation, craniectomies/craniotomies, vasopressors, and anesthetics. After adjusting for markers of illness severity, prophylaxis was associated with mortality (IS: hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.89-2.16; HS: HR 0.83; 95% CI 0.79-0.87; TBI: HR 0.97, 95% CI 0.89-1.06). Prophylaxis was associated with lower home discharge (IS: HR 0.40, 95% CI 0.37-0.42; HS: HR 0.61, 95% CI 0.58-0.64; TBI: HR 0.69, 95% CI 0.68-0.72). Across all acute brain injuries, mechanical ventilation exhibited strong association with outcomes.

Conclusions: Antiseizure medication prophylaxis was higher in TBI and HS compared with IS. Markers of illness severity (e.g., mechanical ventilation, neurosurgical procedures) were associated with more frequent prophylaxis. Prophylaxis exhibited differential associations with mortality (higher in IS, lower in HS and TBI). Prophylaxis was associated with lower home discharge across all acute brain injuries. We hypothesize that neurologic severity and critical illness severity are primary drivers of outcomes. However, the independent association of ASMs with outcomes warrants further investigation.

急性脑损伤住院成人的真实世界抗癫痫药物预防和预后。
背景:抗癫痫药物(ASM)预防急性脑损伤的证据质量较低。我们检查了ASM预防模式,并探讨了急性脑损伤与医院预后的关系。方法:我们分析了PINC AI医疗数据库中来自1400多家美国医院的数据。我们纳入了年龄≥18岁的急性脑损伤住院至少2天的成年人(缺血性卒中(IS)、出血性卒中(HS)和创伤性脑损伤(TBI)的国际疾病分类代码),排除了潜在的流行使用者和癫痫/发作患者。索引日期为入院第二天。ASM预防队列在指标日期接受左乙拉西坦或苯妥英;对照组在索引日未接受任何ASM。结果为死亡时间和出院时间。结果:总共有739,213例患者符合条件:568,254例IS, 86,842例HS, 84,117例TBI。有10,959/568,254 (2%)IS患者、31,970/86,842 (37%)HS患者和38,331/84,117 (46%)TBI患者使用了ASM预防。预防性治疗的患者更频繁地接受机械通气、开颅手术、血管加压药和麻醉剂。在调整疾病严重程度的标志物后,预防与死亡率相关(IS:风险比[HR] 2.02, 95%可信区间[CI] 1.89-2.16; HS: HR 0.83; 95% CI 0.79-0.87; TBI: HR 0.97, 95% CI 0.89-1.06)。预防与较低的出院率相关(IS: HR 0.40, 95% CI 0.37-0.42; HS: HR 0.61, 95% CI 0.58-0.64; TBI: HR 0.69, 95% CI 0.68-0.72)。在所有急性脑损伤中,机械通气与预后有很强的相关性。结论:脑外伤和HS患者抗癫痫药物预防率高于IS患者。疾病严重程度的标志(如机械通气、神经外科手术)与更频繁的预防有关。预防与死亡率有不同的相关性(IS较高,HS和TBI较低)。在所有急性脑损伤中,预防与较低的出院率有关。我们假设神经系统的严重程度和危重疾病的严重程度是结果的主要驱动因素。然而,asm与预后的独立关联值得进一步研究。
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来源期刊
Neurocritical Care
Neurocritical Care 医学-临床神经学
CiteScore
7.40
自引率
8.60%
发文量
221
审稿时长
4-8 weeks
期刊介绍: Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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